This week we review the answers to questions 7-12 from the 6th annual UMEM Residency ECG Competition. Make sure to attempt to answer the questions before clicking the red box to reveal the answers and teaching pearls!
Video review of each ECG Case:
Key Teaching Points
Question 7. A 39-year-old male presents after a syncopal episode. He is now asymptomatic, and this ECG was obtained. What is the diagnosis? What is the diagnostic test of choice?
ECG Courtesy Dr. Ben Smedley
Question 7 Answer
- What is the diagnosis? Brugada syndrome
- What is the diagnostic test of choice? Electrophysiology testing, or sodium channel blocker challenge
Question 8. A 31-year-old male presents with chest pain. He is now asymptomatic when this ECG is obtained.
What is the diagnosis? What is the demographic group in which this ECG is most typically found?
Question 8 Answer
- What is the diagnosis? Benign early repolarization variant
- What is the demographic group in which this ECG is most typically found? Young males of Afro-Caribbean descent
Question 9. A 46-year-old woman presents with active chest pain. The following ECG is obtained.
Question 9 Answer
- What is the ECG diagnosis? Lead misplacement, leads V1 & V3 reversed
Question 10. A 35-year-old male presents with palpitations. The following ECG is obtained.
What is the diagnosis? What is the significance of the ST-segment changes? Name 5 other causes of STE in lead aVR (3 points)
Question 10 Answer
- What is the ECG diagnosis? SVT
- What is the significance of ST-segment abnormalities? None (if resolves after conversion)
- Name 5 other causes of STE in lead aVR. LMCA/proximal LAD/triple vessel disease, thoracic aortic dissection, massive PE, severe anemia, sodium-channel blocker toxicity, hyperkalemia, hypokalemia, LBBB, severe LVH
Question 11. An 80-year-old woman presents after a syncopal episode. Her ECG is below.
What is the FULL ECG diagnosis? (3 points) Name 4 other causes of a tall R wave in lead V1 (2 points).
Question 11 Answer
- What is the FULL ECG diagnosis? Normal sinus rhythm with Mobitz I conduction, RBBB, LAFB
- Name 4 other causes of tall R wave in V1 (2pts) Hypertrophic cardiomyopathy, Right ventricular hypertrophy, right heart strain, WPW, hyperkalemia, Brugada, Sodium channel blocker toxicity, posterior MI, dextrocardia, misplaced leads, ventricular beats
Question 12. A 56-year-old male presents with ongoing chest pressure with diaphoresis and vomiting. The following ECG is obtained.
What is the probable diagnosis?
Question 12 Answer
- What is the probable diagnosis? Posterior STEMI